How to Navigate the Emotional Toll of a Mastectomy

When I was diagnosed with breast cancer four years ago, it looked as though I could be treated with a lumpectomy. But when further testing revealed a second lesion in the same breast, that option was off the table. I ended up opting for a double mastectomy, with immediate reconstruction.

It was the right choice — and I was as informed as could be about everything from what the procedure entailed to what the healing would be like. What I didn’t anticipate was the emotional fallout from the procedure, and how the shock waves have continued to this day.

There’s no doubt that a mastectomy, despite its often lifesaving results, embodies loss. The surgery forces women to confront what their breasts meant to them — as women, as sexual beings, and as mothers or potential mothers. The trauma and the grief are real, and no woman’s recovery will look the same as another's.

Knowing more about what to expect after the procedure, though, may help you better cope with the changes.

Women who have a mastectomy sometimes feel guilty for having negative thoughts about the procedure — a treatment that can eradicate the cancer or greatly reduce their risk of developing it, says Carmen Morales, LCSW, a senior social worker at NYU Langone Perlmutter Cancer Center in New York City.

“Women often report feeling as though they have to push their feelings down and use all their energy to get through tests, scans, and treatment,” she says. “It’s exhausting,” and it leaves less room to process the loss.

It’s perfectly normal to experience:

• Grief It’s not wrong or vain to miss your breasts, says Leora Lowenthal, LICSW, a breast oncology social worker at Dana Farber Cancer Institute in Boston. Grieving what’s gone is normal and reasonable.
• Betrayal You might experience a loss of trust in your body. “Prediagnosis, your breasts were mostly about good and positive things, like entering womanhood, sexuality, nursing a baby, and now they represent danger,” says Lowenthal.
• Fear Around Intimacy You may worry that your partner isn’t attracted to you anymore. Meanwhile, your partner may be holding back — either because they don’t want to hurt you physically or upset you emotionally.
• Complicated Feelings About Breastfeeding For women who’ve nursed before, the loss of that link to their child can be painful. For women who have yet to have or nurse a child, there’s the loss of potential.

There are a lot of feelings that can well up after a mastectomy — but addressing them as they arise can help you find closure. Here are a few ways to do that.

• Practice self-love. As sad as you may be about what you’ve experienced, try to remind yourself that this is still your body, and it deserves care. “Thank your body for getting you through a tough time,” says Lowenthal. Try to acknowledge both the sadness and the gratitude.
• Try to rewrite the negative script. “Women who’ve undergone this surgery can sometimes say heartbreaking things about themselves, like ‘I am hideous,’” says Lowenthal. Try to listen to yourself as though you were listening to your closest friend. You’d certainly be gentle and kind to her. Grant yourself the same grace.
• Be selective about who you ask for support. Not everyone will make you feel better — and some can make you feel worse. If you think a friend or relative will suggest that you’re overreacting; that you should be grateful you’re alive; or that you should just think positive and move forward (or something similar), don’t go to that person for support, even if they mean well.
• Be patient with the pace of healing. Your physical appearance immediately after mastectomy surgery or reconstruction doesn’t reflect what you will look like later, and that can be hard to process, says Lowenthal. Give your body time to physically heal, and your mind time to adjust. Don’t feel you even have to look at yourself right away.

Taking steps to heal physically can also help you heal emotionally. Here are some things you can do to feel better.

• Get moving again. Once you’re medically cleared, try undertaking some light exercise, like going for walks or doing some gentle yoga, which can help you reconnect to your body, says Morales. Your cancer center may also offer group activities like meditation classes.
• Educate yourself. “The more you learn about the physical healing process — how long scars take to lighten, for example — the better you may be able to cope with the changes as they happen,” says Morales.
• Splurge a little. Your body just went through an ordeal — so show it a little TLC. For example, “get a fancy cream for your scars, says Lowenthal, or a supportive bra.
• Focus on well-being. Good nutrition, good sleep, writing in a journal or drawing — it all can contribute to a healthier recovery.

Talking to other women who’ve also had a mastectomy can be immensely helpful. Here are some ways to find like-minded people.

• Talk to the social workers at your cancer center or hospital. There may be on-site support groups or virtual groups available.
• Ask your breast surgeon for a referral. They may be able to connect you to patients who are further along in their recovery and are willing to talk to you about your feelings and concerns.
• Search for support groups online. You can find local or virtual support groups on social media or through vetted breast cancer sites such as Susan G. Komen Foundation, Breastcancer.org, or the American Cancer Society.

If you’re still feeling down, or unlike your normal self (even given what you’ve been through), you may need professional help. Here are some signs you may need counseling or therapy.

• You can’t think or distract your way out of a bad day.
• Your sleep is poor — either not sleeping enough, or sleeping too much.
• You’re avoiding things that normally bring you pleasure.
• You’re avoiding intimacy with your partner, or not allowing anyone (or yourself) to see your body.

A professional can help you find healing as you navigate the future.

• Undergoing mastectomy to treat or prevent breast cancer can be emotionally and psychologically difficult for many women.
• It’s normal to feel emotions such as grief and sadness about the loss of your breasts, and full healing can take a long time.
• Be kind to yourself and try to find others who have undergone the same procedure (search for local or virtual support groups). Recruiting a therapist can also help you heal.